These authors contributed equally to this work and should be considered co-first authors.
Course and prognosis of myasthenia gravis: a systematic review
Article first published online: 12 APR 2010
© 2010 The Author(s). Journal compilation © 2010 EFNS
European Journal of Neurology
Volume 17, Issue 7, pages 913–921, July 2010
How to Cite
Mao, Z.-F., Mo, X.-A., Qin, C., Lai, Y.-R. and Olde Hartman, T. C. (2010), Course and prognosis of myasthenia gravis: a systematic review. European Journal of Neurology, 17: 913–921. doi: 10.1111/j.1468-1331.2010.03017.x
- Issue published online: 21 JUN 2010
- Article first published online: 12 APR 2010
- Received 11 November 2009 Accepted 19 February 2010
- systematic review
The clinical course of myasthenia gravis (MG) is variable, and spontaneous remission is still uncommon. Knowledge of the prognostic factors may help understand the course of MG and thus optimize its management. A systematic review search was conducted in MEDLINE and EMBASE for English language studies from 1985 through 2009. We identified additional studies by reviewing bibliographies of retrieved articles and hand search main journal of neurology. Studies evaluating variables associated with or predictive of remission in adult patients with MG were included. Because of methodological heterogeneity, we refrained from statistical pooling, instead, a best evidence synthesis was used for summarizing the results. From 1810 potentially relevant studies, 13 cohort studies met the inclusion criteria. The included studies were heterogeneous considerably in sample size, disease duration, follow-up years, definition of remission, and analysis. Study quality was limited by retrospective design in most studies and lack of multivariate analysis. Time of diagnosis from onset (<1 year) showed strong evidence of predicting a better remission. In studies using completely stable remission outcomes, there was strong evidence that age at onset (<40 years) was of prognostic importance. Furthermore, gender showed no association with remission. Time of diagnosis from onset and age at onset were found to be predictors of remission. Gender does not seem to predict the course of MG. Our findings should be interpreted with caution because of the clinical and methodological heterogeneity of included studies.